Provider Demographics
NPI:1326350737
Name:BALINNANG, REBECCA H (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:H
Last Name:BALINNANG
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:HANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7658 CREEK BND
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-6667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3077
Practice Address - Country:US
Practice Address - Phone:773-975-6709
Practice Address - Fax:773-975-3255
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1001785133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered